Graybill Lauren A, Westreich Daniel, Maseko Bertha, Phanga Twambilile, Nthani Tiyamike, Vansia Dhrutika, Chi Benjamin H, Daniels Julie L, Tang Jennifer H, Bekker Linda-Gail, Pettifor Audrey E, Rosenberg Nora E
Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
Am J Epidemiol. 2025 May 7;194(5):1200-1207. doi: 10.1093/aje/kwae193.
In sub-Saharan Africa, adolescent girls and young women aged 15 to 24 (AGYW) experience a high risk of early and unintended pregnancy. We assessed the impact of youth-friendly health services (YFHS) on pregnancy risk among AGYW who participated in the Girl Power study. In 2016, Girl Power randomly assigned 4 government-run health centers in Lilongwe, Malawi, to provide a standard (n = 1) or youth-friendly (n = 3) model of service delivery. At 6 and 12 months, study participants (n = 250 at each health center) self-reported their current pregnancy status and received a urine pregnancy test. Because of missing pregnancy test results, we used multiple imputation to correct for outcome misclassification in self-reported pregnancy status and applied the parametric g-formula on the corrected data to estimate the effect of YFHS on the 12-month risk of pregnancy. After correcting for outcome misclassification, the risk of pregnancy under the scenario where all health centers offered YFHS was 15.8% compared to 23.2% under the scenario where all health centers offered standard of care (risk difference: -7.3%; 95% CI, -15.5% to 0.8%). Access to a model of YFHS that integrates provider training with youth-friendly clinic modifications and community outreach activities may decrease risk of pregnancy among AGYW relative to standard of care.
在撒哈拉以南非洲地区，年龄在15至24岁的少女和年轻女性（AGYW）面临着意外早孕的高风险。我们评估了青年友好型卫生服务（YFHS）对参与“女孩力量”研究的AGYW怀孕风险的影响。2016年，“女孩力量”研究在马拉维利隆圭随机指定了4家政府运营的卫生中心，分别提供标准服务模式（n = 1）或青年友好型服务模式（n = 3）。在6个月和12个月时，研究参与者（每个卫生中心n = 250）自行报告其当前的怀孕状况，并接受尿液妊娠试验。由于妊娠试验结果缺失，我们使用多重填补法来纠正自我报告怀孕状况中的结果错误分类，并对校正后的数据应用参数g公式来估计YFHS对12个月怀孕风险的影响。在纠正结果错误分类后，所有卫生中心都提供YFHS的情况下，怀孕风险为15.8%，而所有卫生中心都提供标准护理的情况下，怀孕风险为23.2%（风险差异：-7.3%；95%CI，-15.5%至0.8%）。相对于标准护理，获得一种将提供者培训与青年友好型诊所改进及社区外展活动相结合的YFHS模式，可能会降低AGYW的怀孕风险。
